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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Alerting reaction of blood pressure and risk of mortality in an elderly Chinese population

Hypertension Research (2025)Cite this article

Abstract

Hypertension guidelines recommend multiple blood pressure measurements to minimize the potential initial alerting reactions. This study investigated the prognostic significance of this reaction in elderly individuals. The study subjects (aged ≥60 years) were recruited from the suburban Shanghai. Blood pressure was measured three times consecutively with a 60 s interval in the sitting position using an oscillometric device. An alerting reaction was defined as that the first blood pressure reading exceeded the average of the subsequent two readings. In the total of 4512 participants (44.7% men, average age 66.8 years), those with an alerting reaction (n = 2633) were younger than those without (n = 1879; 65.8 vs. 68.0 years, P < 0.0001). During 5.9 years median follow-up (24,576 person-years), 430 and 221 total and cardiovascular deaths occurred, respectively. Adjusted Cox regression analyses showed that individuals with an alerting reaction had an 18% lower risk of total mortality (HR, 0.82; 95% CI, 0.67–0.99; P = 0.04) and 36% lower risk of cardiovascular mortality (HR, 0.64; 95% CI, 0.48-0.89; P = 0.002) than those without alerting reaction. Further categorical analyses on the greater differences showed that the hazard ratio for an alerting reaction of >5 mmHg (n = 1448) versus ≤−5 mmHg (n = 832) was 0.75 (95% CI,0.57-0.99; P = 0.04) and 0.57 (95% CI, 0.38-0.85; P = 0.006) for total and cardiovascular mortality, respectively. In conclusion, this study first identified that the alerting reaction of blood pressure was associated with a notably lower mortality risk in an elderly population. The underlying mechanism should be investigated in future studies.

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Fig. 1
Fig. 2

Data availability

The datasets analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Acknowledgements

We gratefully acknowledge the voluntary participation of the study participants from Zhaoxiang Community, and the technical assistance of the physicians, nurses, technicians, and master and PhD students from Zhaoxiang Community Health Centre (Qingpu District, Shanghai) and the Shanghai Institute of Hypertension (Huangpu District, Shanghai).

Funding

The study investigators were financially supported by grants from the National Natural Science Foundation of China (grants 82270452, 82270469 and 82370426), and National Health Commission (grants 2022YFC3601302 and 2024ZD0527304), Beijing, China, and the Shanghai Commissions of Science and Technology (19DZ2340200) and Health (grant 2024ZZ1028 and special grant for ‘leading academics’ 2022LJ022), Shanghai, China.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials. The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Chang-Sheng Sheng, Qi-Fang Huang, Yan Li & Ji-Guang Wang

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  1. Chang-Sheng Sheng
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  2. Qi-Fang Huang
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  3. Yan Li
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  4. Ji-Guang Wang
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Contributions

JGW and YL contributed to the conception and design of the work. CSS and QFH participated in the data collection. CSS performed data analysis and prepared the first draft of the manuscript together with JGW. All authors critically revised the manuscript and gave the final approval.

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Correspondence to Ji-Guang Wang.

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Conflict of interest

JGW reports having received lecture and consulting fees from Novartis, Omron, Servier, and Viatris. The other authors declare no conflicts of interest.

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Sheng, CS., Huang, QF., Li, Y. et al. Alerting reaction of blood pressure and risk of mortality in an elderly Chinese population. Hypertens Res (2025). https://doi.org/10.1038/s41440-025-02420-8

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